Alcohol when you’re trying to conceive.

I pause when counseling around alcohol. How do I address this difficult subject?

Toronto Public Health is very clear on its relationship to alcohol and pregnancy. Its May 2014 communique references these very clear key messages: There is no safe level of alcohol exposure at any time in pregnancy, and that when planning a pregnancy it is safest to stop drinking alcohol before becoming pregnant.

Without doubt, these are reasonable comments.

At the same time, it puts women who are trying to conceive over an extended period, in a socially very awkward position.

The challenge that I see is that women who are trying to conceive for a month or two are socially in an entirely different position to women who are trying for a year or two.

It can be incredibly awkward to need to refuse all alcohol, in all social situations, at all times, for years at a time, while awaiting a pregnancy that, in many circumstances, should be a private story, or at least not one that you would wish to be exposed in a new social setting. How awful to get raised and knowing glances from others around the table when you decline a social drink!

But I cannot state unequivocally that alcohol is safe and appropriate while trying to achieve pregnancy. For one, some people do self-medicate with alcohol for sleep and anxiety, to serious concerns for those who are in fertility clinics and trying to achieve pregnancy.

The evidence very clearly indicates that alcohol does not promote egg quality or the safety of embryos. Perhaps there are antioxidants such as resveratrol in reasonable doses from red wines from wet regions in the world. But if resveratrol were your goal, it can be found in tablet or dietary form and red wine is not required as part of the process.

But, what of other data that suggests people who drink one drink a day are more likely to live longer than people who abstain? It is possible that alcohol is a vasodilator and increases blood flow, including to the pelvis; but again, I have seen no study and heard no evidence that alcohol in any way helps promote better egg development or uterine lining.

Alcohol is part of the big four substances that people wrestle with in their personal lives, the other three being coffee, cigarettes, and marijuana.

In my clinic, I routinely advise that one cup of coffee a day is fine, cigarettes are to be avoided as the residues have been clearly demonstrated to accumulate within the follicular fluid that surrounds eggs, and there is some evidence that marijuana may reduce implantation rates by interfering with the natural receptors associated with stress and with implantation.

I don’t know what to say about alcohol.

I know if it were my wife who was trying, I would encourage her to have a social drink from time to time throughout the process. If she were drinking alone in the basement, that would be one thing, but light social alcohol in moderation with friends, if it is part of your lifestyle, is a lot to give up for years at a time.

Perhaps, if you want to justify it this way, you could remember that implantation itself does not occur until approximately five to seven days after ovulation. If you know when you ovulate, does that mean it is okay to drink before that moment? I do not know.

I would ask that you be kind to yourself throughout this process of trying to achieve pregnancy, and if you are deciding to abstain from alcohol, I hope you are able to reward yourself in some other fashion. I hope you are able to achieve the same sense of social connection to those around you which is usually why people reach for a glass in the first place.

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